What Causes Neuropathy? Learn the Top 3 Causes of Nerve Pain

In his years of treating nerve pain, Dr. Aparajit Naram, a plastic surgeon at Baystate Plastic & Reconstructive Surgery, has heard it described a lot of ways. “Burning, electrical, stabbing, throbbing, prickling, tingling, and a sensitivity to even the lightest touch are just some of the ways patients describe their experience of nerve pain,” he says. “For some it occurs only in the middle of the night while others may experience discomfort all day long. No matter how or when it’s experienced, uncontrolled nerve pain can be very distressing. The good news is it can often be controlled.”

3 Common Causes of Nerve Pain

Simply put, nerves send signals to your brain that allow you to feel sensations and move your muscles. “For example,” says Naram, “If you touch something sharp or hot, your nerves send a message to your brain to pull back or stop what you’re doing,” says Naram. “Problems arise when nerves are irritated or damaged. In some cases, false signals get sent. The type of damage or irritation and the severity of that damage or irritation influences how the nerve pain is experienced.”

While there are more than 100 different types of nerve damage, the most common causes include:

1. Pinched nerve

Often the result of repetitive motion or from holding your body in one position for long stretches of time, a pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues, such as bones, cartilage, muscles or tendons. A pinched nerve can occur in many parts of the body. Common symptoms include:

• Pain in the area of compression
• Radiating pain, often down a limb
• "Pins and needles" sensation, akin to having a hand or foot “fall asleep”
• Weakness, especially with certain activities
• Numbness or tingling

The most common examples of this type of nerve pain are carpal tunnel syndrome (experienced in the wrist) and cubital tunnel syndrome (experienced in the elbow).

2. Injury to the nerve

Nerves that are cut, stretched, or crushed, may not be able to send signals to the brain or receive them. As a result, muscles near or associated with the nerve may not be able to function fully or at all and there may be a loss of feeling in the area supplied by the affected nerve. Nerve injuries of this type are often the result of a fall, serious accident, or traumatic injury.

3. Medical conditions

Many medical conditions can cause nerve pain including:

• Diabetes
• Viruses (Shingles, Epstein-Barr, HIV, etc.)
• Cancer
• Alcoholism
• Autoimmune disease (Lupus, rheumatoid arthritis, Sjögren's syndrome, etc.)
• Multiple sclerosis
• Vitamin B12 deficiency
• And more

Different conditions may impact a single nerve, a connected group of related nerves, or many nerves in throughout your body. Symptoms also depend on the type of nerve signals affected, and can range from muscle weakness and paralysis, issues with balance, and uncontrolled muscle movement, to tingling, sweating, and even changes in blood pressure.

Unexplained Nerve Pain

The most frustrating type of nerve pain, unexplained nerve pain, is referred to as ‘idiopathic peripheral neuropathy’. Most often experienced in the feet and legs, it can also occur in the hands and feet. Common symptoms include:

• Burning
• Numbness
• Electrical shocks
• Tingling or “pins and needles”
• Pain to the touch

Pain may be constant is often worse at night.

How to Relieve Nerve Pain

Dr. Naram notes that there are many treatment options for nerve pain. They include treatment without medication or surgery, treatment with medication, and treatment with surgery.

Here’s a look at how each works.

Treatment without medication or surgery

The goal of this type of treatment is to get the nerve into a good—or better—position where it’s not being compressed which will help the nerve recover on its own and prevent further irritation or trauma.

Treatment may involve re-educating the nerve to be less sensitive or providing a distraction which can serve to decrease the perception of pain. This often accomplished by adding introducing new stimulation—heat or vibration, for example—for the nerve to process. The new information works to crowd out the pain messages going to the brain and decreases the sensation of pain.

Treatment without medication

Often done in conjunction with a physical therapist or a hand therapist, this type of treatment can be accomplished several ways. It may use a series of stretches and exercises designed to strengthen the affected body party to get the nerve moving and into a healthy position. In some cases, splints are used to improve blood supply. Alternatively, topical ointments such as Icy Hot or capsaicin cream may also be recommended as a means of providing a distraction for the nerve.

Other non-medication approaches that may be prescribed include acupuncture or a TENS Units. The latter uses an electrical pulse to stimulate muscles near the affected nerve and provide a new message and distraction for the nerve.

Treatments with medication

Today, thankfully, there are many prescription medications that may help with nerve pain. Treatment is often guided by a patient’s primary care provider, a pain specialist or a neurologist specializing in certain types of nerve pain. Medication options include anti-seizure medicine, painkillers, local anesthesia (patches or injections), and specific nerve pain medications.

Naram notes that not every medication works for every patient and that some medications have side effects. Even so, he encourages patients to be open to trying different medications and finding a balance that works for them.

Treatment with surgery

In many cases, surgery is the best and easiest option for specific types of nerve pain. The most common surgeries are focused on either releasing a compressed nerve or repairing a damaged or severed nerve.

Releasing a nerve, as is done with procedures like carpal tunnel surgery, helps give a compressed nerve a bit more room.

Nerve repair is most often done in the emergency department. “Kitchen knife injuries and other accidents are common,” says Naram, “and can be addressed using a variety of surgical techniques.”

For patients who have exhausted nonsurgical options and not found relief, an implanted spinal cord stimulator may be considered. Implanted by a spine surgeon, neurosurgeon, or pain medicine doctor, the device consists of thin wires and a small, pacemaker-like battery pack that sends low levels of electricity directly into the spinal cord to relieve pain.

Naram also performs a specialized surgery called targeted muscle reinnervation (TMR) for individuals dealing with nerve pain post-amputation.

As he explains, “TMR surgery can help reduce post-amputation nerve pain by connecting nerves at the site of the amputation to nerves in a nearby muscle. Essentially you rewire the amputated nerve ending to another nerve and create a pathway for signal coming from the damaged nerve.”

TMR has been shown to be highly effective at relieving nerve pain and reducing pain associated with phantom limb syndrome. It can be performed at the time of an amputation or even years after an initial surgery.

Learn More

If you’re struggling with nerve pain, talk to your primary care provider about treatment options.